Clinical Review Published in Journal of the American Medical Association

Release Date: 06/05/2014

Many women experience bothersome urine loss with laughing, coughing and sneezing (stress urinary incontinence) AND on their way to the bathroom (urge urinary incontinence). When women experience both types of urine leakage, their condition is called mixed urinary incontinence. It is estimated that 20 to 36 percent of women suffer from mixed urinary incontinence, which is challenging to diagnose and treat because symptoms vary and guidelines for treatment are not clear.

“Because mixed urinary incontinence involves both types of incontinence, it is difficult to treat. Our goal was to review the diagnosis and management of mixed urinary incontinence in women, with a focus on current available evidence,” said Dr. Myers.

Dr. Myers reviewed 73 published articles that discussed the prevalence, diagnosis, results, and treatment of mixed urinary incontinence. She found that there is high-quality evidence for treating urinary incontinence with weight loss, for treating stress urinary incontinence with surgery, and for treating urge urinary incontinence with medications.

“However, there is a lack of direct, high quality evidence for treating women with mixed urinary incontinence, as well as an absence of clear, diagnostic criteria and management guidelines for these patients. Because of this, treatment usually begins with conservative management emphasizing the most bothersome component,” continued Dr. Myers. “There is a clear need for randomized trials in women with mixed urinary incontinence.”

Women & Infants Hospital is currently a member of the Pelvic Floor Disorders Network (PFDN), a team of doctors and researchers from eight clinical research centers around the country funded by the National Institutes of Health to improve the level of knowledge about pelvic floor disorders such as an overactive bladder. Through research studies, the team will be able to identify the most effective ways to care for women.

Through their participation in the Pelvic Floor Disorders Network, Dr. Myers and her colleagues are currently recruiting patients for the ESTEEM Study – Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence. Vivian Sung, MD, MPH, of Women & Infants Hospital and the Alpert Medical School, is the principal investigator of this national study comparing two approaches for treating mixed urinary incontinence (MUI) in women, a midurethral sling alone or a midurethral sling combined with behavioral pelvic floor muscle therapy before and after surgery.

About Women & Infants Hospital

Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation’s leading specialty hospitals for women and newborns. A major teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women’s medicine, Women & Infants is the 9th largest stand-alone obstetrical service in the country and the largest in New England with approximately 8,500 deliveries per year. A Designated Baby-Friendly® USA hospital, U.S.News & World Report 2014-15 Best Children’s Hospital in Neonatology and a 2014 Leapfrog Top Hospital, in 2009 Women & Infants opened what was at the time the country’s largest, single-family room neonatal intensive care unit.

Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation’s first mother-baby perinatal psychiatric partial hospital, as well as the nation’s only fellowship program in obstetric medicine.